The Halton Outdoor Club
Membership Application Form
Includes Release and Waiver
3310 Palmer Drive, Burlington, ON L7M 1X3
905-634-2012 or 1-877-877-4550 firstname.lastname@example.org
Please complete the Application on-line then print & and send to address
You must fill in
the lower portion by hand.
from Club's website
Please check the activities you are interested in helping with:
Nordic Ski Patrol,
Telephone Work Club Executive,
Membership Fees for November 1, 2012 to October 31, 2013.
Student $30. (full time students of any age)
Family $85. (includes parents and all family members 18 years and
Partial year for first time members only, applies from May 1 till October
31, not for renewals.
Individual (partial year) $25.
Family (partial year) $45.
If applying after August 31, please use regular prices - and it gives you
the balance of current year plus the following year!
Please make cheque payable to
The Halton Outdoor Club and mail to
the club at 3310 Palmer Drive,
Burlington ON, L7M 1X3.
___________________________________________________________________________________________________________________ Release and Waiver must be
signedby all members 18 years and over and
must also be witnessed
by a non-relative.
In consideration of The Halton Outdoor Club (the "Club") accepting
my/our application for participation in an activity of/or or-ganized by the
Club, I/we,_____________________________ hereby for myself/ourselves, our heirs,
executors, administrators and assign, release and forever discharge the Club,
its servants, agents, sponsors, employees, and/or members from any and all
claims, demands, damages, actions or causes of action arising out of or in
consequence of any loss, injury or damage to my/our person or property incurred
while attending at or participating in any activity of, or organized by the
Club, notwithstanding any such loss, injury or damage may arise by reason of the
negligence of the Club, its servants, agents, sponsors, employees and/or
members. Without limiting the generality of the foregoing, I/we further release
any and all recourse which I/we may now or hereinafter have resulting from any
decision of the Club.
Dated at __________________this____of______________,20___
Note: A separate indemnity is required to be completed by parents of
children under 18 years of age. This will be sent to you after receipt of the
above application for family membership, where children are included.